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Moving Toward a Holistic Menstrual Hygiene Management: an Anthropological Analysis of Menstruation and Practices in Western and Non-Western Societies

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Moving Toward a Holistic Menstrual Hygiene Management: an Anthropological Analysis of Menstruation and Practices in Western and Non-Western Societies University of Montana ScholarWorks at University of Montana Graduate Student Theses, Dissertations, & Professional Papers Graduate School 2017 Moving Toward a Holistic Menstrual Hygiene Management: An Anthropological Analysis of Menstruation and Practices in Western and Non-Western Societies Sophia A. Bay Follow this and additional works at: https://scholarworks.umt.edu/etd Part of the Social and Cultural Anthropology Commons Let us know how access to this document benefits ou.y Recommended Citation Bay, Sophia A., "Moving Toward a Holistic Menstrual Hygiene Management: An Anthropological Analysis of Menstruation and Practices in Western and Non-Western Societies" (2017). Graduate Student Theses, Dissertations, & Professional Papers. 11091. https://scholarworks.umt.edu/etd/11091 This Thesis is brought to you for free and open access by the Graduate School at ScholarWorks at University of Montana. It has been accepted for inclusion in Graduate Student Theses, Dissertations, & Professional Papers by an authorized administrator of ScholarWorks at University of Montana. For more information, please contact [email protected]. MOVING TOWARD A HOLISTIC MENSTRUAL HYGIENE MANAGEMENT: AN ANTHROPOLOGICAL ANALYSIS OF MENSTRUATION AND PRACTICES IN WESTERN AND NON-WESTERN SOCIETIES By SOPHIA ANGELIQUE BAY Bachelor of Arts, Anthropology and International Development, University of Montana, Missoula, Montana, 2014 Thesis presented in partial fulfillment of the requirements for the degree of Master of Arts in Anthropology The University of Montana Missoula, MT December 2017 Approved by: Scott Whittenburg, Dean of The Graduate School Graduate School Dr. Kimber Haddix McKay, Chair Medical and Applied Anthropology Dr. Richard Sattler Anthropology Dr. Phyllis Ngai Communication Studies i Bay, Sophia, M.A., Fall 2017 Anthropology Moving Toward a Holistic Menstrual Hygiene Management: An Anthropological Analysis of Menstruation and Practices in Western and Non-Western Societies Chairperson: Dr. Kimber Haddix McKay Educating girls is not only their human right, but also proposed as one of the best investments for improving quality of life in developing countries (Montgomery et al. 2016, 2). Although menstruation is a universal, biological process, it is fraught with cultural stigmas and taboos throughout Western and non-Western societies. Menstrual-related absenteeism is believed to be a primary cause of missed attendance and early dropout rates, so the developing field of menstrual hygiene management (MHM) is seeking to understand and evaluate what factors are contributing to these findings. After the analyzation of the current literature, a more holistic, nine-pronged approach to menstrual hygiene management is proposed for interventions in the Global South through girls’ access to sanitary products, clean toilets, hand washing facilities, puberty education, pain mitigation, a head woman teacher, inclusion of boys and men, improving support at home, and destigmatization. Because of the country’s rich recent history of international attention and aid, Uganda will be utilized as a backdrop to understand what menstrual hygiene management research is currently being conducted, positive and negative conclusions from the studies, and to uncover gaps for future research. ii Abbreviations List CMA- Critical Medical Anthropology CRECCOM- Creative Center for Community Mobilization DFID- Department for International Development GBV- Gender Based Violence GNP- Gross National Product HIPC- Highly-Indebted Poor Country IMR- Infant Mortality Rate INGO- International Non-Governmental Organization LMIC- Low and Middle-Income Countries MDGs- Millennium Development Goals MHM- Menstrual Hygiene Management MHP- Menstrual Hygiene Product MMR- Maternal Mortality Rate NDP- National Development Plan NGO- Non-Governmental Organization SAP- Structural Adjustment Program SBCC- Social and Behavior Change Communication SDGs- Sustainable Development Goals SES- Socioeconomic Status UNICEF- United Nations Children’s Fund WASH- Water, Sanitation, Hygiene WHO- World Health Organization WSSCC- Water Supply & Sanitation Collaborative Council iii Table of Contents CHAPTER ONE: THE ANTHROPOLOGY OF MENSTRUATION 1 Menstruation is Normal 1 Medical Anthropology and Menstruation 5 Using Critical Medical Anthropology to Critically Understand Menstruation and MHM 9 CHAPTER TWO: MENSTRUATION IN WESTERN AND NON-WESTERN CULTURES14 Menstruation in the United States 14 A History of Taboos and Secrecy 17 Views of Menstruation in The UK and Beyond 26 Menstruation in Non-Western Societies: Sacred or Stigmatized 28 Menstrual Huts and Chaupadi 30 Menstruation in Contemporary Taiwan 34 Menstruation Research in Sub-Saharan Africa 40 Menstruation Past and Present 45 CHAPTER THREE: UGANDA AND MENSTRUAL HYGIENE MANAGEMENT 47 Understanding Uganda: A Unique Lens to Menstrual Hygiene Management 47 Case Study One: Schoolgirls in The Rukungiri District 57 Case Study Two: Impact Assessment in The Kamuli District 61 Case Study Three: Sustainable Solutions to MHM 65 CHAPTER FOUR: TOWARDS A HOLISTIC MENSTRUAL HYGIENE MANAGEMENT STRATEGY 69 Proposed Nine Components to A Holistic Menstrual Hygiene Management 69 Ethics of Menstrual Hygiene Management 94 Implementing MHM: From “What” to “How” 97 Why Prioritize Menstrual Hygiene Management? 106 Next Steps 109 References 110 iv CHAPTER ONE: THE ANTHROPOLOGY OF MENSTRUATION Menstruation is Normal Menstruation is a biological experience that transcends race, ethnicity, time period, socioeconomic status (SES), and culture. The beginning of a young girl’s first menstrual cycle is a monumental moment and is a key indicator in a young woman’s transition into womanhood (Boosey et al. 2014, 2). With as many as 300 million girls and women menstruating worldwide every day, this issue affects a significant portion of the world’s population at an immense scale (WSSCC 2013, 3). If menstruation is biological, why isn’t there more dialogue about it? Why is it taboo to have an unused sanitary product visible to not only boys and men, but to other women and girls as well? Why must the wrapped tampon be hidden in a boot or sleeve to go change it in the restroom? Why is it taboo for a girl or woman discuss her menstrual cycle with her partner or anyone else (Freidenfelds 2010, 14)? Upon delving into the literature on menstruation in Western and non-Western cultures it is clear that menstruation typically carries significant stigmas that negatively impact women and their views of their body. The Water Supply & Sanitation Collaborative Council, a UN council based out of Geneva, wrote that “menstruation is a taboo handed down over time to be dealt with privately by women and girls and not shared in public.” This taboo is institutionalized at home, in school, and even on a governmental level, all of which teach girls and women that they should be secretive, private, and ashamed of their bodies (WSSCC 2013, 2). This secrecy has significant effects on how girls see womanhood, their bodies, and themselves. Literature on menstruation across contexts such as rural, urban, poor, and in places like the United States and developing countries, address stigma and taboo, whether 1 it is spoken about directly or used contextually. For instance, a Uganda study analyzing schoolgirls from a rural poor context remarked, “...their nervous laughs, avoidance of eye contact, and the fact that they often turned their faces towards the floor when speaking,” is a common example of how the ingrained taboo and stigma are expressed (Boosey et al. 2014, 4). The WSSCC (2013) suggests that “...one truth is usually universal: women and girls are supposed to cope with menstruation silently and invisibly. They are not supposed to talk about it outside private conversations between women and girls.” It is not only taboo to discuss menstruation with boys and men, but often taboo to discuss with friends or family, including between mothers and daughters (6). Due to this crippling stigma, many girls have no menstruation education of any level before their first menses occurs (see throughout Alam et al. 2017; Adinma and Adinma 2008; Pillitteri 2011; Montgomery et al. 2016; Boosey et al. 2014; Hennegan et al. 2016; Furth and Ch’en 1992). This stigma creates a culture of insecurity and fear in girls, causing not only the physical symptoms of menstruation but psychological ones as well. Regardless of the girl’s or her community’s reaction to menarche, the same process is occurring with the shedding of the uterine lining. Although this seems like it is a simple, physical experience shared women globally, these immense taboos that accompany menstruation in many Western and Non-Western cultures are taking a toll on the physical, psychological, and social well-being of girls and their futures (again, see throughout Alam et al. 2017; Adinma and Adinma 2008; Pillitteri 2011; Montgomery et al. 2016; Boosey et al. 2014; Hennegan et al. 2016; Furth and Ch’en 1992; Limoncelli 2010; WSSCC 2013; WaterAid 2013). This paper will first delve into why analyzing menstruation from an applied and medical anthropological toolkit is beneficial and then will discuss why using Critical Medical Anthropology theory is an ideal theoretical lens to deconstruct the topic. In chapter two, 2 menstruation practices, attitudes, perceptions, and management strategies in both Western and non-Western societies will be analyzed in relation to positive and negative beliefs surrounding the actual process, as well as how people in different cultures handle
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